Home Forums Discussions General Discussion Medicare ERx Reminder

Since 2011 is coming to a close very shortly, I want to remind all E-prescribers who have Medicare patients:

you need to report only 25 cases using G8553 in association with any one of a multitude of qualified face to face encounters to qualify for the 2% bonus. You will automatically receive your 2% bonus on Medicare allowable charges sometime in the fall of 2011. But they state you must report the G-code.

I know the AC community knows all of this, but for those of you who are e-prescribing and FORGOT to report G8553.....you still have time.

Good luck all!

What is G8553?

It is the CPT code to report on medicare claim that you have eprescribed during the visit so that you can get a bonus next year. Must be in association with an E&M code.

I thought it was G8443 !
Has it changed to G8553 ?

I believe it changed in January. We had been using it up until July.

So do I need to go back and resubmit/amend the claims to just do that.
Aggghhh. Didn't know about this.
At least I'll know for next year

NO, you need to submit fresh claims with visit codes. You have 3 days, its worth it!

You need to search each year as Medicare thinks it is good to change - makes it less likely that people will get it right. So Vicki if you can get 25 patients with e prescribing in the next 3 days you would still get the bonus.

Does the 2% apply just to those 25 claims or to all the Medicare claims? Does submitting more than 25 make a difference?

What icd do you use with the icd?
Do we use the code for the condition treated?

do I add the g8553 to a seperate line and link it to the diagnosis codes.
Arthur Lukoff

I think it is for all the Medicare billing, the G8553 goes down as a separate CPT code with the same diagnostic code. In the AC billing page the value autopopulates as 0.

All you need to do is add the G8553 on each person where you send at least one script via eRx. The rebate is on all your Medicare pts. You don't need a specific ICD9 code, but it is specific to E&M codes - office visits are all included.

Here are the codes from MCR:
List 2: eRx Measure Denominator Codes (Eligible Cases)

Patient visit during the reporting period (Current Procedural Terminology [CPT] or Healthcare Common Procedure Coding System [HCPCS] G-codes):

90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109

CPT only copyright 2009 American Medical Association. All rights reserved.
https://www.cms.gov/ERxIncentive/03_How_To_Get_Started.asp#TopOfPage

Happy New Year,

Barbara

Thanks to everyone.
We are finishing them up, as the New Year approaches.
Wow, we really know how to party!!

When I try to add the cpt G8553 to Quick Codes in admin it says cpt does not exist? THanks

you may need to go into the administrative options and add the cpt code. You can put in in your quick code section to make things easier.

should i even bother now since I will be going for the meaningful use incentive and it is my understanding you cannot get erx + meningful use incentives?

Does anyone know if the CPT code for eRX changed in 2011 or is it still G8553?

I can't answer this question but I just wanted to say that it is my understanding that we must choose either the reimbursement for the meaningful use OR the eRx but not both. I am sure we will be able to pull off 3 months of meaningful use by the end of 2011 even if it is in beta form, so you might wait 6 months or so to see how things pan out before submitting the eRx codes. You MIGHT also have a sense by then of how much your reimbursement for the 2010 eRx was to see which is better. I suspect in most cases the $18k for meaningful use will be the bigger prize.

I reported on 56 patients in 2010.

I went to check on where the money was and Medicare said that I had reported on only 2 and that there was no appeal process.

Something stinks.